Sunday, December 28, 2008

Burnout and Suicidal Ideation among U.S. Medical Students

I came across this article in the Annals a few months ago. I have been tapped to lead an electronic journal club in January, and this is the article that I will be using. If anyone has any input that they want included in the discussion, lets hear it.
I know the authors from medical school and have a great deal of respect for them. I exciteded to give it a critical read and will post my thoughts here soon. I will say though, that I know these are huge issues for some medical students.

Thursday, December 11, 2008

Cats, Toxoplasmosis, and Pregnancy

The other night, my vet student roommates lectured me that we "human medicine" doctors need to stop scaring people about pregnant women getting toxoplasmosis from changing garfield's litter box. They claimed that kittens are the only ones to shed it in their feces. So I had to find some proof and here are the articles supporting their claim. In the limited time I spent, I didn't find an article specifically talking about kittens vs. cats, but this is just some of the articles that popped up on OMIM.

Sources of toxoplasma infection in pregnant women: European multicentre case-control study

This was a case control study performed in 6 European cities using 252 pregnant women w/either acute infection or w/IgM for anti-Toxoplasma gondii and 858 controls. Risk factors for infection included undercooked lamb, beef, or game, contact with soil, and travel outside Europe and the United States and Canada. Contact with cats was not a risk factor.

Article found on:

Prevention of toxoplasmosis in pregnancy: knowledge of risk factors.Kravetz JD, Federman DG.

Study was done to compare the knowledge of ocer 100 ob's, internists and fp's when counseling expectant mothers on risk factors for toxoplasmosis. It was found that ob's were more likely to give the appropriate information, but all groups "inappropriately advised avoidance of all cat contact".

Article found on OMIM taken from Infect Dis Obstet Gynecol. 2005 Sep;13(3):161-5.

Tuesday, December 2, 2008

palivizumab for RSV

Tis the season. We spend a lot of time and money getting Synagis (Polivizumab) for our most at-risk patients. How much benefit is there to be gained here?

Two trials, one from the IMpact-RSV Study Group published in Pediatrics in September of 1998, and one from the Cardiac Synagis Study Group, lead author, our own Timothy Feltes, established the role of polivizumab in preventing morbidity in high risk pediatric populations.

1. IMpact-RSV trial Cliff's Notes
  • Palivizumab is a humanized mouse monoclonal IgG antibody against the F protein of RSV.
  • In the study, 15 mg/kg IM polivizumab or placebo was administered monthly for 5 months to infants with GA less than or equal to 35 weeks who were <6 mos of age or infants <24 mos with BPD.
  • It was double blinded and placebo controlled.
  • They showed a 55% reduction in hospitalizations for all comers.
  • For premature infants, this reduction was 78%, and for the BPD group it was 39%.

2. Feltes paper Cliff's Notes
  • Congenital Heart disease had been excluded from the original polivizumab studies.
  • The last drug for RSV (RSV-IGIV) had increased mortality in congenital heart disease patients.
  • This was hypothesized to be secondary to increased viscosity.
  • Study patients were hemodynamically significant CHD patients <24>
  • This was a double blinded placebo controlled trial.
  • Relative reduction in rate of hospitalization of 45% was shown in the polivizumab group.
  • Duration of hospitalization and duration of oxygen therapy during hospitalization were also shown.
  • No associated adverse events were noted.

Congenital Heart Disease

Anybody know any good congenital heart disease web resources?
I've found Yale's to be helpful.